SEMINAR ON HOSPITAL INFORMATION SYSTEM

SUBMITTED TO : MADAM.MRS.SEETHA DEVI SUBMITTED BY:MRS.POORNAVENI KESAVAN SUBMISSION DATE:11-04-2011

GENERAL OBJECTIVES:
At the end of the SEMINAR the students will be able to understand about the topic HOSPITAL INFORMATION SYSTEMand they will apply this knowledge in their professional life.

SPECIFIC OBJECTIVES:
At the end of the SEMINAR the students will be able to understand about to know: Review the introduction of Hospital information system Explain the evolution of Hospital information system Define Hospital information system Enumerate the benefits of Hospital information system Discuss advanced computer applications of Hospital information system Describe common mistakes in selecting IT systems HIS model: Siemens Model Review the research evidence

HOSPITAL INFORMATION SYSTEM: OVERVIEW: The information system department is one of the newest and most dynamic departments of the hospital. Originally applied to automatic the financial and accounting areas, computer technology has now pervaded almost every activity and has revolutionized the flow of information within the hospital. The scale of daily flow of information in a hospital is overwhelming. An endless stream of data begins with the outpatient and admitting departments and emanates from every department throughout the hospital. Some of the information is vital for the care and well-being of patients, while other data enhance the efficiency of the hospital itself. The way the hospital responds to the challenges of information resource management determines the quality of patient care and hence its success. Crucial decisions must be based upon facts established through the managements use of current information. In the early days of computerization when fragmentation was the norm, there was no way hospitals could utilize data as a consolidated resource pool. The outpatient and admitting departments separately collected specific patient information, and the laboratory stored its own data. Many separate systems functioned with little or no data sharing among them. Sometimes, subsystems did not agree. We now have a system that puts together all departmental data into a comprehensive database that can be shared on a hospital-wide basis. Hospitals consist of many diverse groups performing highly specialized functions. It is imperative that these functions are carried out in a well-coordinated manner. This gigantic and seemingly impossible task is being performed as a matter of daily routine

in many hospitals that have been computerized. The individual systems work as a unified whole that fulfills the needs of both the departments and the hospital. Todays state-of- the-art hospital information system has a comprehensive clinical, administrative and financial database and an advanced database management handling technology. Designed to capture edit and store information online and in detail, it delivers maximum responsiveness to online users. It has capabilities for extensive management reporting for all departments without affecting the simultaneous responsiveness for online users. It can handle a wide spectrum of the hospitals requirements from abstracting of medical records and historical reporting to retroactive processing of a patients complete financial data to producing patients bills. DEFINITION OF HOSPITAL INFORMATION SYSTEM: A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines. BENEFITS OF HIS Easy Access to Patient Data to generate varied records, including classification based on demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point, hence enhancing continuity of care. As well as, Internet-based access improves the ability to remotely access such data. It helps as a decision support system for the hospital authorities for developing comprehensive health care policies. Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization. Enhances information integrity, reduces transcription errors, and reduces duplication of information entries.

SOME BENEFITS OF THE UNIFIED SYSTEM:

 One time data capture is sufficient. This makes repeat entries and duplication of information redundant, and saves effort, time and expense. It reduces the possibility of human error. Since the system is event-driven, it can function independently and notify other departments needing the information automatically. Information resource is assurance and up-to-date. One common database makes a powerful information resource available to the entire hospital. Existing applications, forming islands of computerization of departments, can be integrated into a unified system. The system offers information management for the entire hospital while allowing smooth functioning of departmental systems independently. Data mining for research: Various useful reports can be drawn from the common database facilitating efficient and informed management action.

EVOLUTION OF HOSPITAL INFORMATION SYSTEM: Hospital Information system solutions have been around since the birth of mainframes, way back in the early 70s.The United States of America has definitely taken a lead in the evolution, primarily because of its insurance-centric health care delivery system. Insurance-driven systems demand requirements such as third party billing, electronic transfer of patient records, etc. that necessitated computerization. These old generation systems/applications laid emphasis on functions covering the administrative processes like registration, admission and billing with no clinical emphasis. The modern complexity of health care delivery in view of its administrative, legal and clinical interdependencies calls for a total integrated information system with indepth functionality in all areas of administrative, clinical and back office functions, with additional capability to integrate with many laboratory and medical devices. All new hospitals can start with a clean slate with integrated solutions on the latest hardware and network architecture. In addition to Hospital Information System { HIS}, a lot of off-the-shelf office automation and e-mail tools can contribute to a modern HIS making it a Totally Integrated Hospital System.

VARIOUS SYSTEM OF HOSPITALS IN COMPUTERIZATION:

An Integrated system An online, Real time system A patient-oriented system A customizable system A future-oriented system Comprehensive but modular ,and implemented in phases System should be user-friendly System should be scalable System should comply with international standards Vendor with proven expertise and commitment System should be cost-effective

AN INTEGRATED SYSTEM: A system that links all the computerized systems of the hospital so that when complete, there will be an information network that allows online access to the database, ensuring hospital wide utilization of all features and functions expect where security consideration and confidentiality are important. Data should flow smoothly from one system to another without the need for cumbersome interface programs to forcibly fit in unrelated systems. The project calls for the integrated clinical and non clinical modules extensively, internally, with a global integration to Executive Information System for Management Information System (MIS) reporting. A solution so offered would be an integral solution to the extent that relevant information is made available to special users depending on their areas of work. AN ONLINE, REAL TIME SYSTEM: In the high tech health care system, patient records, patient information, etc. should be on line permitting direct, immediate access through terminals, and allowing real time processing in which the computer system records each change and up dates all the necessary files, etc. instantly. For examples, a computerized online appointment system or the intensive care computer that monitors a patients heart functions, breathing etc. is real time. A PATIENT ORIENTED SYSTEM: Hospital transactions and activities revolve around the patient. The computer system is event-driven, which means that each event or patient encounter is captured and

processed as it occurs. Thus, any time a patient is provided service, the integrated database is updated accordingly. A CUSTOMIZABLE SYSTEM: No two hospitals function exactly, as the workflow,etc. vary. The system to be implemented therefore must be capable of being modified to suit the specific needs of every hospital without major changes to the software design. It becomes important therefore to choose a solution that is tailored and capable of easy customization. A FUTURE-ORIENTED SYSTEM: The computer system should be dynamic and designed to meet the challenges of todays health care needs as well as future requirements. The health care system and hardware and software technology change so fast that systems become obsolete. The system should be capable of being easily upgraded to include future requirements. COMPREHENSIVE BUT MODULAR, AND IMPLEMENTED IN PHASES: The system should provide flexibility to first implement those modules most crucial to its environment and to meet immediate needs. This way the cost can be spread over a planned span of time in a phased manner. Every computerized area representing one module should be complete and no part of it should be left to be handled manually. THE SYSTEM SHOULD RE RELIABLE: Any failure in the system will paralyse the whole hospital operation. The software and hardware should be capable of non-stop functioning 24 hours of the day and 365 days of the year. The software should be time-tested with a good track record. SYSTEM SHOULD BE USER-FRIENDLY: Everyone in the hospital including receptionists, clerks, cashiers, nurses, etc. will need to work on the computer. Almost every work is done on it, making it a routine operation. The system should be user-friendly and simple without needing high computer literacy and in-depth training. SYSTEMS SHOULD BE SCALABLE: The ever-growing of the hospitals and rapidly changing technologies, the system chosen needs to be developed on a robust architecture that permits easy scalability to meet future requirements. Both the software and the hardware need to be scalable.

SYSTEM SHOULD COMPLY WITH INTERNATIONAL STANDARDS: HL/7, ASTM, SNOMED, ICD, CPT, etc. are some of the international standards should comply with. Compliance with these standards provides for uniformity of systems worldwide and facilities easy interfacing of subsystems. VENDOR WITH PROVEN EXPERTISE AND COMMITMENT: It is not uncommon to see vendors who provided Hospital Information System (HIS) solutions to hospitals eventually winding up their operations, leaving the hospital systems with little or no support or upgrades. It is important therefore to choose a vendor who is committed to HIS activities with an established track record and who has committed resources into providing constant upgrades/enhancements. SYSTEM SHOULD BE COST-EFFECTIVE: Both installation and maintaining the system should be cost-effective.

SOME ADVANCED COMPUTER APPLICATIONS: In the area of Diagnostic Imaging Bedside computer system Organization Systems Administration/Database Administrator Application specialist and trainer Hardware/network Engineers Guide to purchasing software and hardware Acquire software first

IN THE AREA OF DIAGNOSTIC IMAGING: Expectional developments have taken place in the application of computer and data communication technology to diagnostic imaging leading to new types of medical information systems such as Pictures Archival & Communication Systems (PACS) The PACS systems is designed to capture radiological images or any other patient information, archive them, assist in their retrieval and distribute them over long distances-all without paper work within the hospital system. The key benefits of PACS are that it allows for image processing and multimedia reporting that assist medical professionals treat the patient better. Its integrated

workflow management system automates workflow in the radiology department, thus saving costs on film and other imaging materials. It also has the advantage of images and records being available anywhere, anytime.

BEDSIDE COMPUTER SYSTEM: The bedside computer system for nursing documentation is a revolutionary concept in nursing care. It allows nurses to record assessments of patients and nursing intervention at the bedside where care of patients takes place. Data is entered on a bedside terminal using specially designed screens that prompt appropriate entries with instantaneous time. This information is then automatically communicated to the computer located at the nurses station where it is arranged in a format, summarized and printed on a laser printer for insertion into the patients chart. Nurses and physicians can inquire into the bedside or nurse station terminal any time to review information about any patient. The primary benefits to nursing are improved productivity and enhanced documentation, eliminating the need for manual data transcription, calculation and graphing by automating the entry of patient data into the chart.

ORGANIZATION: The head of the HIS department is a person who is qualified and experienced in computer systems. Graduate and postgraduate computer diploma/degree holders are available. Depending on the set-up and the extent of computerization and its sophistication, the department may have some or all of the following staff in addition to the head of department.

SYSTEM ADMINISTRATOR/DATDBASE ADMINISTRATOR: The systems administrator-cum-database administrator is responsible for systems administration to ensure high up-time of the system and for handling all database back-up and restoration activities.

APPLICATION SPECIALIST AND TRAINER: The hospitals application specialist together with the software vendor is involved in all the activities required for implementing the application software. Trainers train and retrain new employees in the hospital.

HARDWARE/NETWORK ENGINEERS: Hardware/Network engineers are responsible for maintaining the hardware and network systems in the hospital. They undertake all troubleshooting activities that may be required to ensure high uptime of the servers including the printers and UPS.

GUIDE TO PURCHASING SOFTWARE AND HARDWARE: Managers are generally faced with two difficult questions when purchasing software and hardware: Should I buy or should I wait ? What are the selection criteria for purchase?

The market is swamped with products. New products are introduced into the market all the time, making the earlier ones obsolete. This applies to medical equipment as well, but strangely an administrator would not think twice before purchasing medical equipment as he does about the computer. The most important thing to be done prior to evaluating a software is to define the hospitals needs. This is a time-consuming process that is not easy a novice. It is better to avoid new products until they have established a reputation.

ACQUIRE SOFTWARE FIRST: The most common mistake computer purchases make is to buy hardware first and then look for software programs to run on it. This is like putting the cart before the horse or catching the wrong train. There are two kinds of software that guide and control the computers.

 One is the system software that controls the basic computer devices and provides the necessary structure for memory and file formation. This is generally included in the package price when one buys the hardware. The second is application software that is specifically designed to help one to perform ones tasks on the computer. This includes electronic spreadsheets, database management, word processing, graphics and special function packages. Software may be canned packages or custom made. Packaged software is mass-produced and is relatively inexpensive. Modifications are much more costly, difficult and time-consuming than most of us realize. Selecting reliable software for hospital applications that complements existing procedures ( and hardware) is not easy.

HOSPITALS WILL DO WELL TO USE THE FOLLOWING CRITERIA AS A STARTING POINT: 1. Define the needs for software functions. Some of the points that should receive attention are-size of the user group, frequency of repetitive tasks to be automated, volume of database required, functions and features important to the hospitals needs, specific goals, etc. It should also be remembered that software is written and indexed by industry-for finance, banking manufacturing, business, accounting, health care, etc. 2. Assess the sophistication level required. Software applications may range from very basic to extremely advanced. Packages may be available, but in most cases they need to be customized. A large, integrated system will call for larger expenditure. 3. Document hospital policies and workflow to be adopted and give them to the IT vendor to help customize the HIS product to suit the specific requirements. 4. Keep the future requirements of the hospital and trends in mind. 5. Assess the capability of the vendor in terms of resource commitment to meet the growing and changing needs of the hospitals. 6. Networking is one of the first elements of the total IT should be considered. While designing networking plan, plan ahead for at least three years, by anticipating the nature of data flow (text, image,etc) end-user connections (nodes) and the data load on the network.

7. Evaluate the software documentation-operation, installation and instruction manuals. The operating manual should define instructions step-by-step and clearly. The vendor may also supplement instructions with tutorial diskettes, cassettes and training workshops. 8. Have a hands on demonstration. Do not make your decision on the basis of the demonstration model that comes with the software package. A demonstration model always works to the customers satisfaction. 9. Enquire about the antecedents of the vendor and his strengths and weakness. Find out the firms background and product development trend. 10. Determine whether or not the software is proven in the field. Check when the software was first offered and how many successful installations the vendor has completed. 11. Ascertain the future support that will be provided by the vendor, and whether software upgrades will be offered free of charge as part of the maintenance contract. 12. Compare the costs and terms with other similar software programs. 13. Check availability of training , installation, other services, modifications and custom- made programming. 14. Make provision for changes in application and product development. COMMON MISTAKES IN SELECTING IT SYSTEMS: Often, administration who purchase personnel computers complain about their limitations for hospital application and leave them unused. This is because they fail to realize the importance of selecting the proper software for the intended tasks. Hospitals should avoid some of the mistakes mentioned below while selecting personnel computer software: 1. Many people think that programs that are complex are the best. Most powerful programs can surprisingly be the easiest ones to use. While selecting the software, go in for one that is easy to use. It may be indicative of the depth of thought that has gone into its preparation. 2. Purchasing canned package off the shelf that needs to be modified is not desirable. 3. Using general purpose programs for highly specific applications. For example, trying to accomplish special tasks such as purchasing with word processing or spreadsheet software. 4. Using floppy disks with software designed for hard disk systems. Keeping the massive data generated in the hospital on multiple floppy disks is not a

5. 6. 7.

8.

satisfactory answer. Programs operate faster on a hard disk with higher capacity. Hard disk units are necessary in many areas of the hospital. Automatically manual procedures. An inexperienced manager thinks of tasks that are better done manually as the ones he is going to automate. Not defining objectives clearly or defining them improperly before selecting the software. In such cases, there is no justification for investing money. Purchasing the costlist software assuming that it is the best. Since software is basically the same, managers should consider selecting the least expensive package. They should realize that often there is no direct relationship between complexity, capability and price. Hospitals sometimes assume that developing application software in-house will be cost effective and provide optimum benefits.

SELECTING HARDWARE: Here are few general tips that should be borne in mind while choosing hardware: Check compatibility that has plagued computers since their inception. Popular software packages do not generally operate except on a few microcomputer models. So your options are limited. Start your hardware evaluation process by testing the software package you have selected, and see if it meets the hospitals needs relating to memory size, storage capacity and compatibility with peripheral equipment requirements. Check the compatibility of the software system with the hardware and system software. Consider the hospitals future requirements. Not all computer manufactures offer such an option. Remember, in many model, the specifications you get are what you get when you buy-nothing more. Whatever model you buy, maintainence should receive a priority consideration. Purchase your computer from a reputable dealer who can offer reliable local service. Make a careful assessment of your peripheral equipment requirements. Consider carefully the kind of printer, number of disk drives, storage capacity requirements and furniture needs. If you do not, you may end up incurring some extra cost. Printer cost varies widely depending on the quality of the printer and the additional features it has. Do not entertain the popular misconception that computer operation is easyjust plug it on and start punching in.

 The computer is a tool, and like any other tool, calls for training and a certain amount of skill to operate it.

COMPUTER BREAKDOWN: There are two kinds of computer breakdowns-electronic and mechanical. The latter is more common, more difficult to diagnose and more expensive. Check available options regarding extended warranty on disk drives, printers and other moving parts.

TRENDS AND ADVANCES: Computational capability or computing power has increased in a way that is difficult to comprehend. The computational power that required a room full of equipment ( for example, IBMs mainframe computer) is now be contained in a portable laptop or even palmtop. In advanced countries like America, hospitals and research centres throughout the country are liked in this way making it possible to share data. The increased capability in smaller packages (microprocessors and microcomputers) and decreased cost have resulted in computational ability being applied to a large number of sophisticated uses as seen in microwave ovens, portable calculators amd electronic toys in addition to personal and home computers.

OTHER CONSIDERATIONS: COST OF COMPUTERIZATION: The cost of computerization is often underestimated or miscalculated. There is heavy investment involved especially if a networking type of system is chosen. There is a prevailing misconception that computerization will result in the reduction of staff. The question that is often asked whether computerization at that cost is justified. The answer is yes if one considers increased accuracy, efficiency and speed in patient care and convenience to patient and staff not to mention the elimination of vast amount of manual record keeping and written communication.

PROBLEM SITUATIONS:

CONFIDENTIALITY OF INFORMATION REGARDING PATIENTS: Maintaining confidentiality of patient care information is a primary responsibility of the hospital in the integrated information system ( networking system),where all endusers share the common database, there should be three levels of security: For operators and terminals: An operators password that can be changed regularly, and a terminal level entry control. For patients records: Each record should contain a field specifying either total access or limited access to that patients data. For nursing stations: Security handled at the intelligent terminal level and limiting procedures to that nursing station only. Most good application software have a security module inbuilt, which defines the various roles and privileges corresponding to all users in the system. The module also helps maintain a log of all events in the system to track and monitor the system usage. COMPUTER DOWN TIME: There will be occasions when the computers will be down. All the departments using computers particularly in essential services, should have a contingency procedure for such situations. When the computer is available, pending data must be entered.

HIS SOLUTION: A MODEL: Several HIS solutions are available in the market today, For the benefit of readers, one such package from the reputed Siemens Information Systems, a tested and proven one used by several hospitals in India and abroad, is given in the below.

HOSPITAL INFORMATION SYSTEM: A SIEMENS MODEL: Siemens has been engaged in the health care domain globally for over 150 years, providing a variety of quality health care solutions for hospitals worldwide including medical equipment, medical instruments, imaging solutions, etc,. Strengthened with the expertise of Siemens in offering health care solutions, Siemens Information Systems Ltd ( SISL)-the information technology arm of Siemens- has been the forerunner in conceiving and developing a HIS solution for its wide hospital clientele. Smart cards for storing patient information, remote access facilities across multiple hospital sites, web-enabled HIS and palmtop-enabled technologies are just a few examples of the breakthrough ideas built into the HIS. The total software requirements of a typical hospital can be grouped under two broad categories, namely: Clinical Applications Business Applications (Non-clinical)

SISL, has over the last several years, developed a totally integrated HIS to address the growing needs of a HIS solution both in India and aboard. Several hospitals in India and aboard have derived tremendous advantage to improve their operational effectiveness and efficiency by using this system.

RESEARCH EVIDENCE:

Effect of a nursing information system on the quality of information processing in nursing: An evaluation study using the HIS-monitor instrument
Objectives To assess the changes in the quality of information processing in nursing after the introduction of a computer-based nursing information system. Methods 94 nurses filled out the HIS-monitor survey, comprising 41 questions and focusing on the quality of the information processing, shortly before and again one year after the introduction of a computer-based nursing information system. A McNemar-Bowkertest was used to assess the changes in quality over time. The HIS-monitor instrument was formally validated by calculating Cronbach Alpha. Results Despite some technical problems, the quality of the information processing in nursing significantly improved after the introduction of a computer-based nursing information system in many areas. The results show improved support during patient anamnesis and care planning, higher availability and completeness of nursing documentation, better overview on the patient, better readability of nursing documentation, reduction of duplicate documentation, better workflow support with task lists and checklists, and better fulfillment of the legal regulations. The results with regard to time efforts for nursing documentation and the related impact on patient care were mixed, however. Most of the expectations of the nurses that were stated before IT introduction seem to have been realized. Conclusions The HIS-monitor was found to be a useful instrument, in turn showing that the quality of the information processing in nursing strongly increased after the introduction of a nursing information system.

CONCLUSION AND SUMMARY: By this I gained knowledge regarding HOSPITAL INFORMATION SYSTEM, its introduction, evolution, definition, benefits, various points in selecting a system, some advanced computer applications, common mistakes in selecting IT systems, selecting hardware, HIS models, research evidence,etc. I hope the students understood the topic well and they can apply this knowledge in their professional life. I also thank Madam.Ms. Seetha devi who helped and guided me to present this topic in a good way.

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